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APPLICATION FOR MEMBERSItIP <br /> CITY OF RAMSEY FIRE DEPARTMENT <br />: APR <br />! <br /> <br />: Ngllqe =~HELGESON RICHARD ~L~N <br /> <br />: Permanent Address 3430 pLACEit AVE. ANOKA MN 55303 <br />: s~re~t cny <br /> <br />smte zip <br /> <br />Distance from Permanent Residence to Ramsay City Hall <br /> <br />:Amyou 18 years or older? YES_,~_NO_I. Phone Number (..612)422 . 1811 <br />Position desired, r.F~RE FIGHTER. Date you can start IMqEEDXATEL¥ <br /> <br />I <br />I <br />I <br /> <br />I! <br /> <br />Have you fled an application here before? YES NO x If yes, give date <br /> <br />Referral Source: Ad Friend X Relative__ W'~-ln__ Other __ <br /> <br />Are you now employed? <br /> <br /> Ncrtb S,tar <br />~plo~r <br /> <br /> 800 <br />XO¢ess <br /> <br />YES__ NO_~X If yes, please complete the following: ~I.~g.~._._~!f <br /> <br />List hours t~vailable any time <br /> Mom Tuc, , Thur. Pti. <br />Please provide current D.L #, Class & Expiration Date: <br /> <br />LicensegH-422-730-040-929 Class C-O Expiraiion Date <br />Related education/experience for fire fighting. NONE <br /> <br />SaL Sun. <br /> <br />12-6-94 <br /> <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br /> <br />PERSONAL REFERENCES <br /> <br />Please~ u~ 3 .... ~ ' <br /> ~.,. v.~,,v,,~ you nave hmo-,m for a le~t I ye~ nor reia~ ro you. <br /> <br /> Yea_rs <br /> Name Address Phone Occupation Acquainted <br /> <br /> Cr=-iz Mammeng_~_ 3A91 Pl~c~ ~'~re ~:22-11.77 maint. <br />. Dale Weidner 3At! Placer Ave 32g-9590 Anoka firefighter <br /> <br />I <br />I <br /> <br />3 yrs I <br /> 5 yrs <br /> <br />, PPg~! g~iferth 'qRfl6_l,4Ot-.h lv~ ,~7116211 Consumer Manager 5 year <br /> <br />I au~o~ ~ve~on of ~ s~men~ con[~ed ~ ~is application ~ may ~ necess~ ~o de[e~e <br />eH~biHty for mem~p. I ce~ ~at ~swe~ ~ven here~ ~e ~e ~d complete to ~e ~ of my <br />~owl~ge ~d t ~de~d ~ ff ~cepmd, fasffied s~emenu on thk apphc~on sh~ ~ go~ds <br />for ~B~ I ~de~d ~d ~e ~ak if ~cepted. my membe~hip is for no d e~ta peN od md may <br /> <br />I <br />I <br />I <br /> <br /> <br />